CARDIOVASCULAR MEDICINE

¹ Department of Cardiology, Royal Infirmary, Edinburgh, UK
² Public Health Sciences, University of Edinburgh, Medical School, Edinburgh, UK
³ Department of Radiology, Borders General Hospital, Melrose, Roxburghshire, UK
⁴ Department of Cardiology, Western General Hospital, Edinburgh, UK

Correspondence to:
Professor David E Newby
SU.314 Chancellor’s Building, University of Edinburgh, Edinburgh EH16 4SA, UK; d.e.newby{at}ed.ac.uk

Objectives: To evaluate the effect of intensive lipid-lowering treatment on coronary artery calcification in a substudy of a trial recruiting patients with calcific aortic stenosis.

Methods: In a double blind randomised controlled trial, 102 patients with calcific aortic stenosis and coronary artery calcification were randomly assigned by the minimisation technique to atorvastatin 80 mg daily or matched placebo. Coronary artery calcification was assessed annually by helical computed tomography.

Results: 48 patients were randomly assigned to atorvastatin and 54 to placebo with a median follow up of 24 months (interquartile range 24–30). Baseline characteristics and coronary artery calcium scores were similar in both groups. Atorvastatin reduced serum low density lipoprotein cholesterol (–53%, p < 0.001) and C reactive protein (–49%, p < 0.001) concentrations whereas there was no change with placebo (–7% and 17%, p > 0.95 for both). The rate of change in coronary artery calcification was 26%/year (0.234 (SE 0.037) log arbitrary units (AU)/year; n = 39) in the atorvastatin group and 18%/year (0.167 (SE 0.034) log AU/year; n = 49) in the placebo group, with a geometric mean difference of 7%/year (95% confidence interval –3% to 18%, p = 0.18). Serum low density lipoprotein concentrations were not correlated with the rate of progression of coronary calcification (r = 0.05, p = 0.62).

Conclusion: In contrast to previous observational studies, this randomised controlled trial has shown that, despite reducing systemic inflammation and halving serum low density lipoprotein cholesterol concentrations, statin treatment does not have a major effect on the rate of progression of coronary artery calcification.

Abbreviations: AU, arbitrary units; BELLES, Beyond Endorsed Lipid Lowering with EBT Scanning; CRP, C reactive protein; LDL, low density lipoprotein; SALTIRE, Scottish Aortic Stenosis Lipid Lowering Therapy, Impact on Regression

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Monzack, E. L., Gu, X., Masters, K. S. (2009). Efficacy of Simvastatin Treatment of Valvular Interstitial Cells Varies With the Extracellular Environment. Arterioscler. Thromb. Vasc. Bio. 29: 246-253 [Abstract] [Full Text]  
• McCullough, P. A., Agrawal, V., Danielewicz, E., Abela, G. S. (2008). Accelerated Atherosclerotic Calcification and Monckeberg's Sclerosis: A Continuum of Advanced Vascular Pathology in Chronic Kidney Disease. CJASN 3: 1585-1598 [Abstract] [Full Text]  
• How, P. P., Mason, D. L., Lau, A. H. (2008). Current Approaches in the Treatment of Chronic Kidney Disease Mineral and Bone Disorder. Journal of Pharmacy Practice 21: 196-213 [Abstract]  
• Awan, Z., Alrasadi, K., Francis, G.A., Hegele, R.A., McPherson, R., Frohlich, J., Valenti, D., de Varennes, B., Marcil, M., Gagne, C., Genest, J., Couture, P. (2008). Vascular Calcifications in Homozygote Familial Hypercholesterolemia. Arterioscler. Thromb. Vasc. Bio. 28: 777-785 [Abstract] [Full Text]  
• Anand, D. V., Lim, E., Darko, D., Bassett, P., Hopkins, D., Lipkin, D., Corder, R., Lahiri, A. (2007). Determinants of Progression of Coronary Artery Calcification in Type 2 Diabetes: Role of Glycemic Control and Inflammatory/Vascular Calcification Markers. J Am Coll Cardiol 50: 2218-2225 [Abstract] [Full Text]  
• Erbel, R., Mohlenkamp, S., Kerkhoff, G., Budde, T., Schmermund, A. (2007). Non-invasive screening for coronary artery disease: calcium scoring. Heart 93: 1620-1629 [Full Text]  
• Cassidy-Bushrow, A. E., Bielak, L. F., Sheedy, P. F. II, Turner, S. T., Kullo, I. J., Lin, X., Peyser, P. A. (2007). Coronary Artery Calcification Progression Is Heritable. Circulation 116: 25-31 [Abstract] [Full Text]  
• Schurgers, L. J., Spronk, H. M. H., Soute, B. A. M., Schiffers, P. M., DeMey, J. G. R., Vermeer, C. (2007). Regression of warfarin-induced medial elastocalcinosis by high intake of vitamin K in rats. Blood 109: 2823-2831 [Abstract] [Full Text]  
• Waxman, S., Ishibashi, F., Muller, J. E. (2006). Detection and Treatment of Vulnerable Plaques and Vulnerable Patients: Novel Approaches to Prevention of Coronary Events. Circulation 114: 2390-2411 [Full Text]  
• Cademartiri, F (2006). Is calcium the key for the assessment of progression/regression of coronary artery disease?. Heart 92: 1187-1188 [Abstract] [Full Text]